Topic

Trikafta / Kaftrio (elexacaftor/tezacaftor/ivacaftor)

A collection of 36 issues

Getting Trikafta (Elexacaftor/Tezacaftor/Ivacaftor) Covered by Aetna CVS Health in Michigan: Prior Authorization, Appeals, and Alternative Options

Quick Answer: Getting Trikafta Covered by Aetna CVS Health in Michigan Trikafta requires prior authorization from Aetna CVS Health with CFTR genotype testing (≥1 F508del mutation), cystic fibrosis diagnosis (ICD-10 E84.x), age ≥2 years, and baseline liver function tests. Submit via CVS Caremark Specialty pharmacy with 2+ weeks lead

How to Get Trikafta (elexacaftor/tezacaftor/ivacaftor) Covered by Cigna in Georgia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Trikafta Covered by Cigna in Georgia Cigna requires prior authorization for Trikafta (elexacaftor/tezacaftor/ivacaftor) with complete CFTR genotype testing, CF specialist prescription, and clinical documentation. Standard approval takes 5 business days; expedited reviews available in 24-72 hours for urgent cases. If denied, Georgia law provides strong

Myths vs. Facts: Getting Trikafta Covered by Blue Cross Blue Shield in Washington (2025 PA Guide)

Answer Box: Trikafta requires prior authorization from all Blue Cross Blue Shield plans in Washington, including Premera and Regence. Success depends on proper CFTR genotype documentation (F508del mutation), CF specialist attestation, and complete clinical records—not just a prescription. If denied, you have 180 days to appeal and can request

Cigna's Coverage Criteria for Trikafta in Florida: What Counts as "Medically Necessary"?

Answer Box: Getting Trikafta Covered by Cigna in Florida Cigna requires prior authorization (PA) for Trikafta in Florida with documented cystic fibrosis diagnosis (ICD-10 E84.0), confirmed CFTR genotype (F508del or responsive mutations), and prescription from a CF specialist. Standard PA review takes 5 business days; expedited review available for

Getting Trikafta Covered by Aetna CVS Health in Georgia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Trikafta Covered by Aetna CVS Health in Georgia Trikafta requires prior authorization through CVS Caremark specialty pharmacy for Georgia Aetna members. Submit PA with CFTR genotype showing ≥1 F508del mutation, CF specialist prescription, and medical necessity letter. If denied, file internal appeal within 180 days, then Georgia

Work With Your Doctor to Get Trikafta Approved by Cigna in New York: Complete PA Guide and Appeal Process

Answer Box: Getting Trikafta Approved by Cigna in New York Cigna requires prior authorization for Trikafta (elexacaftor/tezacaftor/ivacaftor) in New York. Your CF specialist must submit genetic testing showing F508del or responsive CFTR mutation, diagnosis confirmation (ICD-10 E84.0), and medical necessity documentation. Submit electronically via CoverMyMeds for fastest

How to Get Trikafta Approved by Blue Cross Blue Shield in Georgia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Trikafta Covered by BCBS Georgia Trikafta requires prior authorization from Blue Cross Blue Shield of Georgia (Anthem). To get approved: (1) Have your CF specialist submit a PA through Anthem's provider portal with genetic testing showing F508del or eligible CFTR mutations, (2) Include diagnosis (ICD-10

How to Get Trikafta Covered by UnitedHealthcare in California: Complete Prior Authorization & Appeals Guide

Quick Answer: Trikafta requires prior authorization from UnitedHealthcare in California. Submit via the UHC Provider Portal with CF diagnosis, CFTR genotype results, and specialist attestation. Standard approval takes 5-10 business days. If denied, file an internal appeal within 60 days, then request California DMHC Independent Medical Review (IMR) within 6

Getting Trikafta (elexacaftor/tezacaftor/ivacaftor) Covered by Blue Cross Blue Shield of Illinois: Complete PA Guide and Appeal Process

Answer Box: Getting Trikafta Covered in Illinois Trikafta requires prior authorization (PA) from Blue Cross Blue Shield of Illinois for cystic fibrosis patients aged ≥2 years with qualifying CFTR mutations. Submit genetic testing confirming F508del or eligible mutations, pulmonologist prescription, and CF diagnosis (ICD-10 E84.0-E84.9) via BCBSIL PA

Get Trikafta Covered by Cigna in North Carolina: Complete Prior Authorization & Appeals Guide

Answer Box: Getting Trikafta Covered by Cigna in North Carolina Cigna requires prior authorization for Trikafta (elexacaftor/tezacaftor/ivacaftor) with documented cystic fibrosis diagnosis, CFTR genetic testing, and CF specialist prescription. Submit electronically via CoverMyMeds or fax the official Cigna PA form with ICD-10 code E84.0, genetic test results,